Automated E-mail Messaging as a Tool for Improving Quit Rates in an Internet Smoking Cessation Intervention
- Affiliations of the authors: Department of Medicine, University of California, La Jolla, CA (LL); Veterans Affairs San Diego Healthcare System, San Diego, CA (LL, AB); Department of Psychiatry, University of California, San Francisco, CA (RFM, JEP); San Francisco General Hospital, San Francisco, CA (RFM)
- Correspondence and reprints: Leslie A. Lenert, MD, HSRD Section, MC 111N1, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161; e-mail: < >
- Received 23 September 2003
- Accepted 3 March 2004
Objective The aim of this study was to determine whether an automated e-mail messaging system that sent individually timed educational messages (ITEMs) increased the effectiveness of an Internet smoking cessation intervention.
Design Using two consecutive series of participants, the authors compared two Web-based self-help style smoking cessation interventions: a single-point-in-time educational intervention and an enhanced intervention that also sent ITEMs timed to participants' quit efforts. Outcomes were compared in 199 participants receiving the one-time intervention and 286 receiving ITEMs.
Measurements Demographic factors, number of cigarettes smoked, nicotine addiction, depressive symptoms, and confidence in ability to quit were measured at entry. Twenty-four–hour quit attempts and seven-day point-prevalence of abstinence (nonrespondents assumed to smoke) were measured 30 days after each subject's self-selected quit date.
Results The one-time and ITEMs groups differed in some demographics and some relapse risk factors but not in factors associated with 30-day quit rates. ITEMs appeared to increase the rate at which individuals set quit dates (97% vs. 91%, p = 0.005) and, among the respondents to follow-up questionnaires (n = 145), the rate of reported 24-hour quit efforts (83% vs. 54%, p = 0.001). The 30-day intent-to-treat quit rates were higher in the ITEMs group: 7.5% vs. 13.6%, p = 0.035. In multivariate analyses controlling for differences between groups, receiving ITEMs was associated with an increase in the odds ratio for quitting of 2.6 (95% confidence interval = 1.3–5.3).
Conclusion ITEMs sent on strategic days in smokers' quit efforts enhanced early success with smoking cessation relative to a single-point-in-time Web intervention. The effect appears to be mediated by ITEMs' causing smokers to plan and undertake quit efforts more frequently.
Supported by grants 7RT-0057 and 10RT-0326 from the Tobacco Related Disease Research Program of the University of California (Ricardo F. Muñoz, Primary Investigator). Dr. Muñoz is supported through the University of California, San Francisco/San Francisco General Hospital Latino Mental Health Research Program, which is funded by the University of California Committee on Latino Research. The authors thank the members of the programming and development team, including Aditya Bansod, Dawna Perkins, and Jacquie Parry, who helped design the e-mail messaging system, and members of the team that developed the online educational content, including Eliseo Pérez-Stable, Jacqueline Stoddard, and Carlos Penilla.